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Prior authorization for prescribers

Help manage costs, control misuse and protect patient safety to ensure the best possible therapeutic outcomes with prior authorizations (PA).

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Submitting a PA request

Certain medications require approval, or prior authorization (PA), to ensure they are medically necessary, covered and appropriate for the reason prescribed. PA reviews are completed by clinical pharmacists and/or medical doctors.

Including supporting documentation for a PA

To ensure that a PA determination is provided to you in a timely manner, please submit all documentation needed to make a decision. Lack of information may delay the decision-making process and may result in an authorization denial unless all required information is received.

Save time and submit your PA requests to Optum Rx through one of the following online portals1

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Submit an e-PA using the CoverMyMeds provider portal.

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Electronic prior authorization

Submit an e-PA using Surescripts prior authorization portal.

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Get faster approval by submitting electronic prior authorizations

Providers who use an e-PA for medication requests, on average, spend 2.5 fewer hours on PAs per week2.

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Electronic prior authorization (e-PA)

Benefits of using e-PA

  • Real-time submissions at no additional cost
  • Eliminates phone wait time and manual faxes  
  • Reduces disruptions to patient care
  • Create renewals from previous submissions 
  • Clinical documentation can be submitted electronically 
  • Reduces paperwork and protects secure encrypted PHI3
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Prior authorization resources for prescribers

Our three dynamic pharmacy solutions make it easy for your patients to get their medications, when and where they need them.

Electronic PA submission options:

Verbal PA submission option:

  • Call 1-800-711-4555, option 2 to request a verbal prior authorization
    5 a.m.–10 p.m. PT, Monday-Friday and 6 a.m.–3 p.m. PT, Saturday


Optum Infusion Pharmacy medical benefit coverage: please contact our Infusion Pharmacy team.

For Specialty and Infusion Pharmacies

Due to Medicare regulation 42 CFR § 423.566(c), CoverMyMeds® no longer allows specialty pharmacies to submit Medicare Part D to plans. Because of this, prescribers must submit the completed prior authorization to the plan.

Committed to getting patients on therapy fast

Optum will still do all the pharmacy work to create the PA. Once complete, we will share the request key for your review of the completed PA, so all you need to do is submit. All other plans will continue in the established process.

CoverMyMeds prior authorization process for Medicare Part D patients:

  1. Optum will create the PA in CoverMyMeds
  2. Optum will send you PA request key
  3. Prescriber visits: CoverMyMeds
  4. Prescriber enters the request key, patient last name and date of birth
  5. Prescriber reviews the PA and submits

If you cannot submit requests to the Optum Rx Prior Authorization Department through e-PA or telephone, additional forms can be accessed here.

Our Utilization Management (UM) Program uses drug-specific PA guidelines to assess drug indications, set guideline types (step therapy, PA, initial or reauthorization) and determine approval criteria, duration, effective dates and more.

  • Call 1-800-711-4555 to request Optum Rx standard drug-specific guideline to be faxed or mailed to you


Click here to review PA guideline changes.

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  1. The ePA solution supports all forms of PA and formulary exception requests. Exclusions may include cost reduction requests such as tiering exception, copay waiver, and tier cost sharing. To submit these requests, please contact our PA department at 1-800-711-4555.
  2. Based on CoverMyMeds Industry Provider Survey.
  3. Provides secure transmission using the National Council for Prescription Drug Programs (NCPDP) standard.